Non-surgical treatment of condylar fractures in adults: a retrospective analysis.

PURPOSE: The aim of the study was to investigate the results of non-surgical treatment of condylar fractures in a group of 60 patients with 71 condylar fractures, in order to establish a protocol to select patients for surgical treatment of condylar fractures. MATERIAL: Out of a group of 91 patients treated in a non-surgical fashion, 60 patients with a total of 71 condylar fractures responded to the request for follow-up. METHODS: Retrospective study, including clinical analysis of occlusion, asymmetry at rest and during mouth opening, maximum interincisal distance, signs of TMJ-dysfunction and analysis of radiographic data, i.e. shortening of the ascending ramus as measured on sequential orthopantomograms. RESULTS: There were five patients (8%) with an unacceptable malocclusion of which one also had considerably limited mouth opening. Fifty-five patients (92%) had none or only minor signs of TMJ-dysfunction not requiring further treatment. CONCLUSION: Only in selected patients with shortening of the ascending ramus of 8mm or more and/or considerable displacement of the condylar fragment, surgical repositioning and rigid internal fixation should be considered.

The transconjunctival approach with lateral canthal extension for three-wall orbital decompression in thyroid orbitopathy.

BACKGROUND: Graves' disease associated orbitopathy (thyroid orbitopathy) gives rise to a characteristic facial appearance and aesthetic concerns due to exophthalmus and eyelid abnormalities, most notably upper eyelid retraction. Involvement of ocular muscles or compression of the optic nerve near the orbital apex can lead to diplopia and decreased visual acuity. METHODS: Seven patients with thyroid orbitopathy were operated upon and their charts retrospectively reviewed. Orbital decompression was performed through a bilateral transconjunctival approach with lateral canthal extension for aesthetic correction of proptosis, functional problems and decrease of visual acuity. RESULTS: Mean pre-operative Hertel values of 23 mm for the left eye and 23 mm for the right eye decreased significantly with 5.4mm and 4.7 mm, respectively. Functional problems improved in 75% of the patients whereas when visual acuity was the indication for surgery only minor changes were observed. The patient operated solely for aesthetic reasons was extremely satisfied with her outcome. Additional surgery (strabismus and eyelid correction) was necessary in 70% of the patients. Complication rate was low with permanent hypoaesthesia of one infra-orbital nerve (one out of 14). No infective complications were noted and scarring was hidden. CONCLUSION: Based on the findings of this study and review of the literature it is concluded that the transconjunctival approach with lateral canthal extension is a safe and very effective route when surgical decompression of the orbit is indicated and therefore should be considered the approach of first choice.

The use of the pedicled supraclavicular flap in noma reconstructive surgery.

Three noma patients with large unilateral facial defects were reconstructed using the pedicled supraclavicular flap technique in the Noma Children Hospital in Sokoto, Nigeria. The results are-although not completely perfect-encouraging enough to report and to repeat the technique in future reconstructive noma surgery after moderate modifications. It is advised not to tunnel the pedicle in the neck, but instead to open the neck. Then, the flap can be inset in a Z-plasty fashion to close the neck without the chance of compression of the pedicle of the flap. In this way flap necrosis can be prevented, without the risk of a scar contracture of the neck. Another technique, which can prevent partial flap necrosis and loss of tissue, with the need for secondary stage interventions, is a delay procedure of the flap. Incorporation of the fascia in the pedicled supraclavicular flap can be another option to fulfil the abovementioned requirements.